tips and tricks

Know that you are part of something bigger. Your profession is part of your identity and the values of collegiality should underlie your day to day practice. You will have the opportunity with any new patient to trash your colleagues who also may be local competitors. Some of the dentistry that has been done in the past in these patients may not seem ideal but it is not up to us to judge work that has been done in the past. We don't know the whole truth about what the conditions were like at the time and what pressures the previous dentist was put under. When we see these patients or are asked to comment previous work we have to realise that the same thing will happen to patients we see. They may go to another practice and you would hope that the next dentist doesn't judge your work too harshly out loud to the patient. No one's work is perfect, everyone has off days and makes compromises to fit the situation. Instead, we should aspire to treat our colleagues with respec...

Continuing the theme of correcting my younger colleagues, I thought it would be pertinent to look back at my old posts and correct any concepts that I now disagree with. Looking back I can remember some of the situations that prompted me to post on such matters and seeing them again with the eyes of experience sheds a different light on the subject. http://dental-tidbits.blogspot.com/2014/03/blog-post.html My very first post on this blog. Apparently I did continue the blog haha.. http://dental-tidbits.blogspot.com/2014/03/011-soft-tissue-exam.html The plaque free before the examination is probably something I should do more of these days. It is not possible to examine a dentition well that is covered in plaque. If the plaque is so thick that it hinders examination I would love to plaque dye it and take photos to show the patient what the problem is. This can be a powerful tool to motivate. I don't check TMJ and lymph nodes routinely but it definitely wouldn't hurt to do...

Someone at work was asking me questions yesterday because her daughter is going through dental school and experiencing back and neck pain that is making it difficult to go about her daily life. She is understandably very upset and severely regretting her career choice. I will summarise the information that I have on the subject: -I started by saying this is normal. I then changed that statement to: This is not normal, but it is common. Pretty much every dentist will experience neck and back pain in their career at some point. Pain is a sign that something in the body isn't as it should be. Just because something is common, doesn't mean we have to accept it as normal . Pain this early on in her career is a sign that something is seriously wrong and needs to be fixed asap. -Back and neck pain is a sign of poor ergonomics. It is not surprising that this happens when you consider what it is we do. We work on very small objects to margins a fraction of a millimeter in a dark envi...

Working in the hospital system I see many patients who have slipped through the cracks or haven't contacted the hospital so haven't been seen for many years. So I have had the benefit of seeing sequential radiographs sometimes over 20 years. No doubt this is the same situation in long standing private practices. With the benefit of hindsight I can see things that have worked and things that haven't. Carious lesions that I would have gone straight to RCT have been treated with deep fillings and show no periapical lesions years later. Periodontally compromised teeth that the patient refused to extract or didn't return for treatment were still present sometimes decades later. It has allowed me to appreciate the role in occlusal forces in the rate of degeneration of periodontally affected teeth noting that patients with short faces and large masseters seem to have looser teeth at younger ages when combine with perio. Seeing these xrays and extracting many periodontally comp...

I had a question in the past about how to extract canines without fracturing the buccal plate. Due to their bulkier buccolingual dimension, canines tend to stick out of the arch at the neck. This couple with the generally thin dimension of bone at the maxillary anterior region, extraction of maxillary canines often result in the loss of the buccal plate of bone which results in a significant defect after healing. Today I performed a full clearance including the extraction of 2 maxillary canines and 1 mandibular canine. Despite the loss of almost 60% of bone height, the canines still provided a challenge to extract. One maxillary canine I managed to fracture a large portion of the buccal plate and the other one I didn't. Anecdotally, this is what I did differently between them: -Fractured the buccal plate: Luxated all around the tooth, Moved to forceps once there was slight mobility. Mainly my force was towards the buccal and the extraction was quick after the buccal plate fract...